多体位颈椎MRI诊断颈椎病

目的探讨多体位颈椎MRI对颈椎病的诊断价值。方法对30例临床诊断为颈椎病的患者进行颈椎中立位、过屈位、过伸位MR检查,比较三种体位下颈椎椎间盘突出矢状径指数(SI)的差异。结果 30例中共发现颈椎椎间盘突出92个,两两组间比较,三种体位下SI差异均有统计学意义(P<0.05);过屈位椎间盘突出程度最轻,过伸位椎间盘突出程度最重。结论不同体位下颈椎MR检查显示椎间盘突出程度有所差异。多体位颈椎MRI对于临床选择颈椎病治疗方案有着重要意义,也为研究颈椎病发病机制提供了新的方法。

脊髓型颈椎病术后神经功能恢复时间模式研究

目的探讨脊髓型颈椎病术后神经功能恢复时间的模式。方法对42例继发于椎管狭窄的进行性脊髓型颈椎病患者施行外科手术治疗,前方手术入路24例,后方入路18例。于术后1,3,6,12,18个月各随访1次,之后每年随访1次,进行JOA评分。结果术前JOA评分为1~15分,平均8.3分。10例严重患者JOA评分〈6分,术后6个月在随访中保持平稳的JOA平均值为13.3分（3~17分）。最后一次随访应用Hirabayash i技术评估平均为52.5%。神经功能恢复表现在术后第1—3个月,而后维持稳定。JOA评分〉6分和JOA评分〈6分病例神经功能恢复非常相似。在前路与后路手术方式中,患者的神经功能康复无显著性差异。结论该型患者神经功能恢复在术后6个月表现非常迅速,之后则表现平稳,与初始病变严重程度无关。更多比JOA评分系统有效的评分系统应该发展起来应用于此类患者的随访过程中。

机器人辅助颈椎后路椎弓根螺钉置入手术治疗颈椎病的置钉精确度与临床疗效

目的探讨机器人辅助颈椎后路椎弓根螺钉置入手术治疗颈椎病患者的置钉精确度与临床效果。方法纳入2018年4月至12月上海交通大学医学院仁济医院脊柱外科采取手术治疗的颈椎病患者18例。其中男11例,女7例,年龄(60.7±5.41)岁。依照手术方式将患者分为机器人辅助椎弓根螺钉置入(RA)组(8例)和传统徒手椎弓根螺钉置入(CF)组(10例)。比较2组患者的手术时间、术中出血量、透视次数、累计透视时间和辐射剂量以及住院时间;采用Rampersaud分类标准评价螺钉置钉的准确性;采用颈椎日本骨科协会评分(JOA)和颈椎功能障碍指数(NDI)评估术后患者神经功能恢复情况;采用Odom's评分评估末次随访时患者满意度。结果2组患者的基线特征、术中出血量、住院时间等差异无统计学意义(均P>0.05)。RA组与CF组“绝对安全区”(A级)椎弓根螺钉置入率分别为91.8%和49.2%,“相对安全区”(A+B级)椎弓根螺钉置入率分别为98.0%和83.6%,“可疑安全区”(C+D级)椎弓根螺钉置入率分别为2.0%和16.4%。RA组和CF组手术时间分别为(326.3±78.55)min和(242.0±26.99)min,术中透视次数分别为(14.9±2.53)次和(18.2±1.48)次,累计术中透视时间分别为(2.3±0.94)min和(3.5±0.50)min,患者所暴露辐射剂量分别为(45.3±17.60)Gy和(62.2±6.03)Gy,差异均有统计学意义(P=0.006,0.003,0.003,0.039)。2组随访时间内JOA评分、NDI评分和患者满意度差异均无统计学意义(均P>0.05)。结论骨科机器人辅助与传统徒手颈椎后路椎弓根螺钉置入手术治疗颈椎病均可取得相似满意疗效;骨科机器人辅助技术可以提高颈椎后路椎弓根螺钉置入的精确度,同时可以显著减少患者和术者X线暴露。

Expression of c-fos in gastric myenteric plexus and spinal cord of rats with cervical spondylosis

AIM: To determine the expression of c-fos in gastric myenteric plexus and spinal cord of rats with cervical spondylosis and its clinical significance. METHODS: A cervical spondylosis model was established in rats by destroying the stability of cervical posterior column,and the cord segments C4-6 and gastric antrum were collected 3, 4 and 5 mo after the operation. Rats with sham operation were used as controls. c-fos neuronal counter-staining was performed with an immunohistochemistry method. Every third sections from C4-6 segments were drawn. The 10 most labeled c-fos-immunoreactive (Fos-IR) neurons were counted, and the average number was used for statistical analysis. The mean of Fos-IR neurons in myenteric plexus was calculated after counting Fos-IR neurons in 25 ganglia from each antral preparation, and expressed as a mean count per myenteric ganglion.RESULTS: There were a few c-fos-positive neurons in the cervical cord and antrum in the control group. There was an increased c-fos expression in model group 3, 4 and 5 mo after operation, whereas there was no significant increase in c-fos expression in the control group at 3, 4 and 5 mo.More importantly, there was a significant difference in c-fos expression between rats followed up for 3 mo and those for 5 mo in the model group (11.20±2.26 vs 27.68±4.36,P＜0.05, for the cervical cord; and 11.3±2.3 vs 29.3±4.6,P＜0.05, for the gastric antrum). There was no significant difference between rats followed up for 3 mo and those for 4 mo and between rats followed up for 4 mo and those for 5 mo in the model group.CONCLUSION: c-fos expression in gastric myenteric plexus was dramatically associated with that in the spinal cord in rats with cervical spondylosis, suggesting that the gastrointestinal function may be affected by cervical spondylosis. If this hypothesis is confirmed by further studies, functional gastrointestinal diseases such as functional dyspepsia and irritable bowel syndrome could be explained by neurogastroenterology.

A preliminary study of neck-stomach syndrome

AIM: To determine the expression of c-Fos, caspase-3 and interleukin-1β (IL-1β) in the cervical cord and stomach of rats with cervical spondylosis, to analyze their relationship, and to offer an explanation of one possible cause for functional dyspepsia (FD) and irritable bowel syndrome (IBS) caused by cervical spondylosis. METHODS: The cervical spondylosis model in rats was established by destroying the stability of cervical posterior column. The cord segments C4-6 and gastric antrum were collected 3 mo and 5 mo after the operation. Rats with the sham operation were used as controls. The expressions of c-Fos, caspase-3 and IL-1β in the cervical cord and gastric antrum were determined by immunohistochemistry and/or Western blot. RESULTS: Immunohistochemical staining showed a few c-Fos, caspase-3 and IL-1β-positive cells in the cervical cord and antrum in the control. There was a significant increase in c-Fos, caspase-3 and IL-1β expression in model groups compared to the control groups at 3 mo and 5 mo after operation. More importantly, there was a significant (P < 0.05) increase in c-Fos, caspase-3 and IL-1β expression in the model group rats at 3 mo compared to those at 5 mo after the operation (c-Fos: 11.20 ± 2.26 vs 27.68 ± 4.36 in the cervical cord, 11.3 ± 2.3 vs 29.3 ± 4.6 in the gastric antrum; caspase-3: 33.83 ± 3.71 vs 36.32 ± 4.01 in the cervical cord, 13.23 ± 3.21 vs 26.32 ± 4.01 in the gastric antrum; IL-1β: 42.06 ± 2.95 vs 45.91 ± 3.98 in the cervical cord, 26.56 ± 2.65 vs 32.01 ± 2.98 in the gastric antrum). Western blotanalysis showed time-dependent changes of caspase-3 and IL-1β protein in the cervical cord and gastric antrum of rats with cervical spondylosis; there was no significant expression of caspase-3 and IL-1β protein in the control group at 3 mo and 5 mo after the sham operation, whereas there was a significant difference in caspase-3 and IL-1β protein levels between the model group rats followed up for 3 mo and those for 5 mo (P < 0.05). CONCLUSION: There is a significant association of c-Fos, caspase-3 and IL-1β expressions in the gastric antrum with that in the spinal cord in rats with cervical spondylosis, suggesting that the gastrointestinal function may be affected by cervical spondylosis.

MULTI-CENTER RANDOMIZED CONTROLLED TRIALS OF COMBINED TREATMENT OF VERTEBRAL ARTERY TYPE CERVICAL SPONDYLOSIS WITH ACUPUNCTURE AND MASSAGE

Objective.To evaluate the clinical value of synthetical therapy of acupuncture and massage for treating vertebral artery type cervical spondylosis （VACS）. Methods： In the present study, triple-center, single-blind, randomized and control methods were adopted. Qualified subjects were randomly assigned to three groups： acupuncture-massage （acu-mas） group, acupuncture group, and massage group （60 subjects in each group）. Bilateral Fengchi （风池 GB 20）, Jiaji （夹脊 EX-B 2, C4-7） and Baihui （百会 GV 20） ware punctured in combination with massage at the neck-shoulder and back region. The treatment was conducted once daily, 14 times altogether. Results. After treatment, of the 60 cases in each of acu-mas, acupuncture and massage groups, 28, 11 and 13 were cured, 13, 20 and 17 markedly effective, 12, 14 and 16 effective, and 7, 15 and 14 ineffective, with the total effective rates being 88.3%, 75.0% and 76.7% respectively. The therapeutic effect of acu-mas group was significantly superior to that of simple acupuncture and massage groups （P〈 0.05）. The scores of clinical symptoms and signs in 3 groups all declined significantly after treatment （ P〈 0.01 ）, and the score of symptoms of acu-mas was markedly lower than those of acupuncture and massage groups （P〈 0.05）. No significant differences were found among 3 groups in the score of clinical signs and between acupuncture and massage groups in the score of clinical symptoms （P〉0.05）. The time for producing therapeutic effects in acu-mas group was significantly shorter than those of acupuncture and massage groups （P〈0.01, 0.05）, meanng a faster of aou-mas group in producing clinical effect. No adverse events ware found in all the 3 groups. Conclusion： Acupuncture and massage are effective and safe in the treatment of VACS, and the therapeutic effect of acupuncture combined with massage is superior to that of simple acupuncture and simple massage therapy.

颈椎活动受限患者三种插管方式的效果比较

回顾性分析我院2012年6月到2014年6月进行的96例伴颈椎活动受限全身麻醉气管插管患者的临床资料。均采用相同麻醉诱导，其中行纤维支气管镜（纤支镜）、视可尼喉镜和McCoy喉镜插管各32例。与McCoy喉镜相比，视可尼喉镜插管患者气管插管总成功率、一次成功率较高而插管时间较短，术后并发症率较低（均P〈0．05）。与纤支镜插管患者相比，视可尼喉镜插管患者的插管时间较短（P〈0．05），各时间点心率、平均动脉压及氧饱和度，气管插管总成功率、一次成功率及并发症率差异均无统计学意义（P〉0．05）。采用视可尼喉镜插管对血流动力学影响较小，且插管时间短，更适用于颈椎活动受限患者气管插管。

Clinical Observation on Treatment of Cervical Spondylotic Radiculopathy with Combined Electroacupuncture Tuina and Traction

Objective： To observe the clinical effect of combined electroacupuncture, tuina. and traction treating cervical spondylotic radiculopathy. Method： Depending on the orders of the patient＇s first visit, 120 cases were randomized into a treatment group （60 cases）, receiving electroacupuncture, tuina and traction treatment, and a control group （60 cases）, receiving electroacupuncture and tuina treatment. The treatment was done once a day, and 5 times constitute one course of treatment. A 2-day interval is set between the courses. The therapeutic effect was evaluated after 6 courses of treatment. Result： The total effective rate and recovery rate in the treatment group were 93.3% and 61.7%, respectively, whereas that of the control group were 78.3% and 31.7%, respectively, showing a significant statistical difference. Conclusion： Combined acupuncture, tuina and traction worked well for cervical spondylotic radiculopathy.

Clinical effect observation on liver-regulating and blood-tonifying acupuncture for cervical spondylosis of vertebral artery type

Objective： To observe the clinical effect of liver-regulating and blood-tonifying acupuncture in the treatment of cervical spondylosis of vertebral artery type. Methods： A total of 60 cases meeting the inclusion criteria were randomized into an observation group and a control group, 30 cases in each group. Cases in the observation group received liver-regulating and blood-tonifying acupuncture, in which Jiaji （EX-B 2） points of C3_C7, Ganshu （BL 18） and Geshu （BL 17） were used; cases in the control group received routine acupuncture treatment in which jiaji （EX-B2） points of C3.C7 were used. Both groups received 5 times of treatment in a week with a 2-day rest, symptoms evaluation was done after 4 weeks of treatment, and then therapeutical effect was evaluated. Results： The total effective rate was 90.0% in the observation group, 73.3% in the control group, and inter-group comparison showed a statistical significance （P〈0.05）. After treatment, the symptoms and signs scores in both groups all substantially dropped, showing statistical significances （both P〈0.05）; inter-group comparison showed that the improvements in subscales of dizziness, pressing pain along vertebrae and revolve-cervix test in the observation group were superior than those in the control group, showing statistical significances （all P〈0.05）, while the inter-group comparisons of subscales of headache and vomiting and nause didn＇t show any statistical significances after treatment （both P〉0.05）. Conclusion： Liver-regulating and blood-tonifying acupuncture is effective in treating cervical spondylosis of vertebral artery type, and it can significantly improve patients＇ symptoms and signs.

Effects and Mechanisms of Needle Pricking Therapy and Rotating-pulling Manipulation on Blood Velocity of Patients with Vertebral Artery Type of Cervical Spondylosis

Objective： To compare the effects of needle pricking therapy plus rotating-pulling manipulation and rotating-pulling manipulation on blood velocity, angiokinesis, and blood viscosity in patients with vertebral artery type of cervical spondylosis （CSA）, and discuss its mechanisms. Methods： 216 patients were randomly divided into 2 groups according to numeric representation, 108 cases in the treatment group were treated by needle pricking therapy plus rotating pulling manipulation, and 108 cases in the control group were treated by rotating pulling manipulation. The peak systolic blood velocity （Vpeak）, end diastolic blood velocity （Vmin）, pulsatile index （PI） and resistant index （RI） of the bilateral vertebral arteries （VA） and basilar arteries （BA） were examined by transcranial doppler sonography （TCD）. The values of whole blood apparent viscosity and plasma viscosity of both groups were recorded. The indexes before and after treatment of both groups were compared. Results： The therapeutic effects of the above-mentioned indexes of the treatment group were significantly superior to those of the control group （P〈0.05）. In comparison with pre-treatment, the whole blood apparent viscosity （high, medium and low shear rates） and plasma viscosity of the treatment group post-treatment were obviously reduced （P〈0.01, P〈0.05）. Conclusion： Needle pricking therapy combined with pulling-rotating manipulation can significantly improve VATCS patients＇ clinical symptoms, which may be closely related to its effects in lowering vascular blood resistance and blood viscosity and increasing cerebral blood supply.

Therapeutic efficacy observation on bloodletting and cupping for cervical radiculopathy

Objective： To observe the efficacy and safety of bloodletting and cupping for cervical radiculopathy. Methods： The randomized controlled clinical trial was conducted in five centers. A total of 183 eligible subjects were randomly allocated into a bloodletting group （n=68）, an acupuncture group （n=56） and a combined group （n=59）. Patients in the bloodletting group were treated with bloodletting at Dazhui （GV 14） and Jianjing （GB 21） on the affected side, coupled with 5-10 min of cupping, 5 mL blood for each cup, 2-3 cups for one treatment. Patients in the acupuncture group were treated with needling cervical Jiaji （EX-B 2） points and Jianjing （GB 21） on the affected side. The needles were retained for 30 min. Patients in the combined group were treated with both methods. The treatment in all three groups were done once every three days, twice a week, 4 weeks for a course of treatment, for a total of 1-3 courses. Then the therapeutic efficacy was evaluated using scores of visual analogue scale （VAS）, neck disability index （NDL） and clinical assessment scale （CAS） before treatment and after 1, 2 and 3 courses of treatment. Results： The scores of VAS, NDI and CAS in all three groups were significantly decreased after 1, 2 and 3 courses of treatment （all P〈0.001）, and there were no inter-group statistical significances in comparing scores of VAS, NDI and CAS （all P〉0.05）. Conclusion： Bloodletting and cupping share the similar effect with acupuncture in pain relief and improvement of quality of life in patients with cervical radiculopathy.

Clinical Observation on Needling Tendon for Cervical Spondylosis Causing Vertebral Artery Insufficiency

Objective： To observe the clinical effect of needling tendon for cervical spondylosis causing vertebral artery insufficiency. Methods： Thirty-eight cases with cervical spondylosis causing vertebral artery insufficiency were treated by needling the cervical tendon for one-course treatment. After treatment, the vertebrobasilar blood flow was observed. Results： The vertebrobasilar blood flow of the patients was substantially improved. The total effective rate and marked effect rate were 100.0% and 68.4% respectively. Conclusion： Needling the cervical tendon can obtain an exact effect for cervical spondylosis causing vertebral artery insufficiency.

Observation on Efficacy of Acupoint Injection Combined with Traction for Cervical Radiculopathy

Objective： To observe the therapeutic effect of acupoint injection combined with traction for cervical radiculopathy. Methods： A hundred and twenty-two patients with cervical radiculopathy were randomly divided into 3 groups, including an observation group （42 cases）, an acupoint injection group （40 cases） and a traction group （40 cases）. The patients in the first group received acupoint injection combined traction therapy, while the ones in the second and the third group received acupoint injection and traction respectively. The differences of therapeutic effect were evaluated after the treatments. Results： The total effective rate of the observation group was 92.9%, while it was 72.5% in the acupoint injection group and 75.0% in the traction group. There were significant differences between the observation group and the other two groups respectively （P〈0.05） , but there was no statistic difference between the acupoint injection group and the traction group. Conclusion： Acupoint injection combined with traction treatment was more effective for the cervical radiculopathy than either acupoint injection or traction.

Clinical Study on Treatment of Cervical Spondylopathy with Acupuncture plus Thunder-fire Moxibustion

Objective： To observe the clinical effects of acupuncture plus thunder-fire moxibustion for cervical spondylopathy. Methods： Sixty cases who met the inclusion criteria were randomly divided into a treatment group and a control group, 30 cases in each group. The cases in the treatment group were treated by acupuncture plus thunder-fire moxibustion, while those in the control group were treated by single acupuncture alone. The changes in the symptoms, sign integrals and visual analogue scale （VAS） before and after treatments were observed. Results： The cases in the treatment group were better than those in the control group in the enhancement of clinical effects, the decline of VAS scores and the improvement of clinical symptoms and sign integrals, with statistical significance （P0.01 or P0.05）. Conclusion： Acupuncture plus thunder-fire moxibustion can obviously relieve pain and improve the cervical functions of the patients with cervical spondylopathy.

Treatment of 157 Cases of Cervical Spondylosis of Vertebral Artery Type by TuinaTherapy

Objective： To observe the clinical efficacy of tuina therapy in the treatment of cervical spondylosis of vertebral artery type. Methods： One hundred and tiffy-seven cases of cervical spondylosis of vertebral artery type were treated by tuina therapy, three times a week. Ten treatments made up one course and one to two courses of treatment was performed. During tuina treatment, other modalities that may affect tuina effects were discontinued. The patients were surveyed three months after tuina treatment. Results： Among the 157 cases, 109 cases obtained marked effectiveness, 26 cases improvement and 6 cases ineffectiveness; 16 cases were not surveyed. The total effective rate was 86.6%. Conclusion： Tuina therapy has excellent effects on cervical spondylosis of vertebral artery type.

Effect observation on heat-sensitive moxibustion for cervical spondylosis of vertebral artery type

Objective： To observe the difference of the therapeutic effect between heat-sensitive moxibustion and warm needling therapy for cervical spondylosis of vertebral artery type （CSA）. Methods： A total of 60 cases with CSA who met the inclusion criteria were randomly divided into a heat-sensitive moxibustion （HSM） group and a warm needling therapy （WNT） group according to the visiting sequences, with 30 cases in each group. Patients in the former group were treated by heat-sensitive moxibustion, while patients in the latter group were treated by warm needling therapy. Both groups were treated once every other day, with 10 times as 1 course of treatment, and the therapeutic effects were evaluated after I course of treatment. Results： After 1 course of treatment, the total effective rate of the HSM group was 93.3%, versus 83.3% in the WNT group. There was a statistically significant difference between the two groups （P〈0.05）. Conclusion： Heat-sensitive moxibustion has better therapeutic effect for CSA than warm needling therapy.

Observation on clinical effect of acupuncture for cervical spondylosis of vertebral artery type

Objective： To observe the clinical effect of acupuncture therapy to support yang and consolidate the constitution for cervical spondylosis of vertebral artery type （CSA）. Methods： A total of 72 patients with CSA were randomly divided upon the random digital table into an acupuncture- moxibustion group and an acupuncture group, 36 cases in each group. The acupuncture-moxibustion group was treated by electroacupuncture （EA） at bilateral Fengchi （GB 20） and C4-6 Jiaji （EX-B 2）, in combination of moxibustion at Baihui （GV 20）, Shenshu （BL 23） and Mingmen （GV 4） to support yang and consolidate constitution. The acupuncture group was given by routine EA at bilateral Fengchi （GB 20）, cervical Jiaji （EX-B 2）, Tianzhu （BL 10）, Jianjing （GB 21）, Houxi （SI 3）, Hegu （LI 4） and Waiguan （TE 5）. The treatment was given once every day and continuous six sessions made one course. After 2-course treatment, the improved situation of clinical symptoms and clinical effect were observed in the two groups. Results： The total effective rate was 91.7% in the acupuncture-moxibustion group and 61.1% in the acupuncture group. The difference of the total effective rate between the two groups was statistically significant （P〈0.05）. After treatment, the scores of the clinical symptoms in the two groups were obviously decreased than those of the same group before treatment （P〈0.01）. The differences in the scores between the two groups were statistically significant （P〈0.05）. Conclusion： Acupuncture-moxibustion treatment to support yan~ and consolidate constitution is better than the routine acupuncture therapy in the therapeutic effect for CSA.

Therapeutic Efficacy Observation on Tuina Therapy for Cervical Spondylotic Radiculopathy in Adolescence: A Randomized Controlled Trial

Objective： To investigate the short-term and long-term effects of manipulation for cervical spondylotic radiculopathy in adolescence. Method： All 120 cases were randomly allocated into an observation group and control group. Then the immediate effects and relapse rates after 6 months in both groups have been observed. Results： The short-term effect in the observation group superior to the control group （P0.05） and the relapse rate after 6 months in the observation group was significantly lower than the control group （P0.05）. Conclusion： Manipulation can obtain good short-term and long-term effect for cervical spondylotic radiculopathy in adolescence.

Clinical Experience on Treatment of Cervical Spondylosis with Combined Acupuncture, Tuina and Psychotherapy

Cervical spondylosis is common in the middle-aged or senile population and can greatly affect theirbody-mind health. The common treatmentmethods include traction, tuina, acupuncture andmedication. However, psychological factors, suchas anxiety, depression or fear are often neglectedduring the treatment. The authors investigated theeffect of combined psycho- therapy, acupunctureand tuina on the cervical spondylosis.

Research Progress of Electroacupuncture Treatment on Cervical Spondylosis Radiculopathy in Recent Ten Years

Objective： To introduce electroacupuncture （EA） treatment on cervical spondylosis radiculopathy （CSR） at home and abroad in the prior ten years. Methods： EA, combined EA and other treatments for NCS are classified and analyzed. Results： The most commonly used acupoints are JiaJi （Ex-B2）, Fengchi （GB 20）, Waiguan （TE 5）, Quchi （LI 11）. EA is widely applied to treat CSR because of its definite therapeutic effects and safety. Conclusion： The validity of other evaluation indexes needs to be proved by more rigorously designed randomized controlled trials （RCT） with scientific methods.